. . . "Guidelines; Perforated peptic ulcer; Postoperative mortality; Preoperative risks; Prophylaxis"@en . "23" . "P\u0159ehledov\u00E1 pr\u00E1ce \u010Derp\u00E1 z odborn\u00E9 literatury posledn\u00EDch 10 let a zab\u00FDv\u00E1 se p\u0159edopera\u010Dn\u00EDmi rozikov\u00FDmi vlivy, kter\u00E9 ovliv\u0148uj\u00ED v\u00FDskyt poopera\u010Dn\u00EDch komplikac\u00ED a mortalitu u perforovan\u00E9ho peptick\u00E9ho v\u0159edu. Existuje \u0159ada vliv\u016F, kter\u00E9 jsou jasn\u011B spojeny se zv\u00FD\u0161enou morbiditou a mortalitou u tohoto onemocn\u011Bn\u00ED. Pat\u0159\u00ED mezi n\u011B p\u0159edev\u0161\u00EDm vy\u0161\u0161\u00ED v\u011Bk, komorbidity, malnutrice, \u0161okov\u00FD stav p\u0159i p\u0159ijet\u00ED a \u010Dasov\u00FD interval od vzniku p\u0159\u00EDznak\u016F do operace. N\u011Bkter\u00E9 faktory v\u0161ak nelze ovlivnit, proto je mortalita u tohoto onemocn\u011Bn\u00ED obt\u00ED\u017En\u011B redukovateln\u00E1. Na druh\u00E9 stran\u011B lze pomoc\u00ED detekce rizikov\u00FDch faktor\u016F l\u00E9pe pacienty stratifikovat a t\u00EDm redukovat v\u00FDskyt poopera\u010Dn\u00EDch komplikac\u00ED. K ur\u010Den\u00ED v\u00FD\u0161e rizika slou\u017E\u00ED n\u011Bkter\u00E9 sk\u00F3rovac\u00ED syst\u00E9my, jako je sk\u00F3re podle Boey nebo Mannheimsk\u00FD peritone\u00E1ln\u00ED index. Metodou prvn\u00ED volby z\u016Fst\u00E1v\u00E1 v\u010Dasn\u00FD opera\u010Dn\u00ED v\u00FDkon, kter\u00FD je zalo\u017Een na sutu\u0159e perforace s plomb\u00E1\u017E\u00ED v\u0159edu omentem a s lav\u00E1\u017E\u00ED a dren\u00E1\u017E\u00ED peritone\u00E1ln\u00ED dutiny. Ukazuje se, \u017Ee pou\u017Eit\u00ED dren\u00E1\u017Ee, rutinn\u00ED poopera\u010Dn\u00ED zaveden\u00ED nazogastrick\u00E9 sondy i pod\u00E1v\u00E1n\u00ED antibiotik by m\u011Blo b\u00FDt racion\u00E1ln\u011B zkr\u00E1ceno jen na nezbytnou dobu a pou\u017Eito u selektovan\u00E9 skupiny pacient\u016F. Neexistuj\u00ED siln\u00E9 d\u016Fkazy, kter\u00E9 by up\u0159ednost\u0148ovaly v l\u00E9\u010Db\u011B v\u0159edov\u00E9 choroby inhibitory protonov\u00E9 pumpy p\u0159ed blok\u00E1tory histaminov\u00FDch receptor\u016F. Profylaxe stresov\u00E9ho v\u0159edu u pacient\u016F v intenzivn\u00ED p\u00E9\u010Di by m\u011Bla b\u00FDt pod\u00E1v\u00E1na jen u rizikov\u00FDch pacient\u016F bez enter\u00E1ln\u00EDho p\u0159\u00EDjmu. Nemocn\u00ED s enter\u00E1ln\u00ED v\u00FD\u017Eivou nemaj\u00ED z profylaxe p\u0159\u00EDnos a naopak jsou ohro\u017Eeni vznikem nozokomi\u00E1ln\u00ED pneumonie a klostridiov\u00E9 kolit\u00EDdy."@cs . "Perforovan\u00FD peptick\u00FD v\u0159ed - p\u0159edopera\u010Dn\u00ED rizika, poopera\u010Dn\u00ED morbidita a mortalita, profylaxe v intenzivn\u00ED p\u00E9\u010Di a doporu\u010Den\u00ED"@cs . "Anesteziologie a Intenzivn\u00ED Medic\u00EDna" . . . . "5"^^ . "Perforovan\u00FD peptick\u00FD v\u0159ed - p\u0159edopera\u010Dn\u00ED rizika, poopera\u010Dn\u00ED morbidita a mortalita, profylaxe v intenzivn\u00ED p\u00E9\u010Di a doporu\u010Den\u00ED" . "RIV/47813059:19510/12:#0000279" . . "[6A103A7181C9]" . . "N" . "Perforovan\u00FD peptick\u00FD v\u0159ed - p\u0159edopera\u010Dn\u00ED rizika, poopera\u010Dn\u00ED morbidita a mortalita, profylaxe v intenzivn\u00ED p\u00E9\u010Di a doporu\u010Den\u00ED"@cs . . . . . "158234" . "19510" . . . . "Perforated peptic ulcer - pre-operative risks, postoperative morbidity and mortality, prophylaxis in intensive care and guidelines"@en . "Satinsk\u00FD, Igor" . "1"^^ . . "This review analyses studies reporting preoperative risk factors for postoperative morbidity and mortality in patients with perforated peptic ulcer in the literature in the last 10 years. There exists a number of factors clearly associated with increased morbidity and mortality in this illness: advanced age, co-existing diseases, malnutrition, shock on admission and delayed surgery. Because some of the factors are predetermined, reduction in mortality is difficult to achieve. On the other hand detection of risk factors allows to stratify patients and to reduce the incidence of postoperative complications. Some scoring systems exist to determine the risk level (Boey's score, Mannheim Peritonitis Index). The first choice of treatment is early surgical suture of the perforation and plugging of the perforation with pedicled omentoplasty, accompanied by irrigation and drainage of the peritoneal cavity. The use of drains, routine postoperative nasogastric decompression and antibiotic prophylaxis should be reduced and applied in selected cases only. There is no strong evidence favouring proton pump inhibitors against H2 receptor antagonists. Stress ulcer prophylaxis in intensive care patients should be given to at-risk patients without enteral nutrition only. Patients with enteral nutrition do not benefit from stress ulcer prophylaxis and indeed such therapy may increase the risk of nosocomial pneumonia and colitis."@en . "Perforated peptic ulcer - pre-operative risks, postoperative morbidity and mortality, prophylaxis in intensive care and guidelines"@en . "5" . "RIV/47813059:19510/12:#0000279!RIV14-MSM-19510___" . . "CZ - \u010Cesk\u00E1 republika" . "1"^^ . "1214-2158" . "P\u0159ehledov\u00E1 pr\u00E1ce \u010Derp\u00E1 z odborn\u00E9 literatury posledn\u00EDch 10 let a zab\u00FDv\u00E1 se p\u0159edopera\u010Dn\u00EDmi rozikov\u00FDmi vlivy, kter\u00E9 ovliv\u0148uj\u00ED v\u00FDskyt poopera\u010Dn\u00EDch komplikac\u00ED a mortalitu u perforovan\u00E9ho peptick\u00E9ho v\u0159edu. Existuje \u0159ada vliv\u016F, kter\u00E9 jsou jasn\u011B spojeny se zv\u00FD\u0161enou morbiditou a mortalitou u tohoto onemocn\u011Bn\u00ED. Pat\u0159\u00ED mezi n\u011B p\u0159edev\u0161\u00EDm vy\u0161\u0161\u00ED v\u011Bk, komorbidity, malnutrice, \u0161okov\u00FD stav p\u0159i p\u0159ijet\u00ED a \u010Dasov\u00FD interval od vzniku p\u0159\u00EDznak\u016F do operace. N\u011Bkter\u00E9 faktory v\u0161ak nelze ovlivnit, proto je mortalita u tohoto onemocn\u011Bn\u00ED obt\u00ED\u017En\u011B redukovateln\u00E1. Na druh\u00E9 stran\u011B lze pomoc\u00ED detekce rizikov\u00FDch faktor\u016F l\u00E9pe pacienty stratifikovat a t\u00EDm redukovat v\u00FDskyt poopera\u010Dn\u00EDch komplikac\u00ED. K ur\u010Den\u00ED v\u00FD\u0161e rizika slou\u017E\u00ED n\u011Bkter\u00E9 sk\u00F3rovac\u00ED syst\u00E9my, jako je sk\u00F3re podle Boey nebo Mannheimsk\u00FD peritone\u00E1ln\u00ED index. Metodou prvn\u00ED volby z\u016Fst\u00E1v\u00E1 v\u010Dasn\u00FD opera\u010Dn\u00ED v\u00FDkon, kter\u00FD je zalo\u017Een na sutu\u0159e perforace s plomb\u00E1\u017E\u00ED v\u0159edu omentem a s lav\u00E1\u017E\u00ED a dren\u00E1\u017E\u00ED peritone\u00E1ln\u00ED dutiny. Ukazuje se, \u017Ee pou\u017Eit\u00ED dren\u00E1\u017Ee, rutinn\u00ED poopera\u010Dn\u00ED zaveden\u00ED nazogastrick\u00E9 sondy i pod\u00E1v\u00E1n\u00ED antibiotik by m\u011Blo b\u00FDt racion\u00E1ln\u011B zkr\u00E1ceno jen na nezbytnou dobu a pou\u017Eito u selektovan\u00E9 skupiny pacient\u016F. Neexistuj\u00ED siln\u00E9 d\u016Fkazy, kter\u00E9 by up\u0159ednost\u0148ovaly v l\u00E9\u010Db\u011B v\u0159edov\u00E9 choroby inhibitory protonov\u00E9 pumpy p\u0159ed blok\u00E1tory histaminov\u00FDch receptor\u016F. Profylaxe stresov\u00E9ho v\u0159edu u pacient\u016F v intenzivn\u00ED p\u00E9\u010Di by m\u011Bla b\u00FDt pod\u00E1v\u00E1na jen u rizikov\u00FDch pacient\u016F bez enter\u00E1ln\u00EDho p\u0159\u00EDjmu. Nemocn\u00ED s enter\u00E1ln\u00ED v\u00FD\u017Eivou nemaj\u00ED z profylaxe p\u0159\u00EDnos a naopak jsou ohro\u017Eeni vznikem nozokomi\u00E1ln\u00ED pneumonie a klostridiov\u00E9 kolit\u00EDdy." . "Perforovan\u00FD peptick\u00FD v\u0159ed - p\u0159edopera\u010Dn\u00ED rizika, poopera\u010Dn\u00ED morbidita a mortalita, profylaxe v intenzivn\u00ED p\u00E9\u010Di a doporu\u010Den\u00ED" .